Journal of

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Recently, a new technology called nano-fractional radiofrequency has been developed in the treatment of skin rejuvenation. This novel technology can reduce side effects and recovery time due to the smaller pin size. The clinical trials have reported the effectiveness and safety of this new technology for treating many skin disorders such as rhytides, acne erythema, scarring, rosacea, striae and skin laxity. Despite its growing usage in aesthetic fields many clinical trials are needed to evaluate the effectiveness of this novel technology.

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Background and Aim: Melasma is a common disease affecting quality of life. Available treatments result in the gradual and partial clearance of melasma, and are accompanied with high risk of recurrence after discontinuing treatment. Tranexamic acid has been successfully evaluated in several studies. In addition, laser has been proposed as an enhanced drug delivery method. This study is designed to evaluate this enhancing effect.

Methods: Twenty-five patients with bilateral epidermal and mixed type melasma were recruited in the study and applied tranexamic 5% gel bilaterally on face two times a day and randomly underwent fractional CO2 laser treatment on one side of the face monthly. They were evaluated before starting treatment and then every 4 weeks by measuring modified melasma area severity index (mMASI) and melanin index by Dermacatch (Colorix, Switzerland). Also, quality of life was measured and compared in a subset of patients with MELAS QoL questionnaire before and after treatment. The results were analyzed by SPSS software version 18 and the results were compared by paired t test. Due to multiple comparisons, p value of 0.0125 was considered significant.

Results: The mMASI and melanin index were not significantly different between two sides in each follow up (P>0.0125). The mMASI and melanin index significantly decreased after treatment with tranexamic acid with or without fractional CO₂ laser (P<0.001 and P<0.001, respectively)

Conclusion: Although tranexamic acid 5% gel is effective in the treatment of melasma, however, our study did not show additive therapeutic effect by adding fractional CO₂ laser to it.

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Background and Aim: Undesirable appearance of the scar tissue after aesthetic surgery can affect the outcomes and patient satisfaction. In recent years, early laser therapy had been encouraged to reduce the scar tissue formation. However, the available evidence regarding the outcomes of laser therapy utilizing combined lasers are limited. In the current study, the effects of combined laser therapy using pulsed dye laser (PDL) and fractional CO2 laser on the appearance of the scar tissue after aesthetic surgeries were investigated.

Methods: There were 15 patients enrolled in the current study including 13 mammoplasty and 2 abdominoplasty patients. In mammoplasty, each breast was randomly assigned to the laser therapy or control group. In abdominoplasty, split scar design was used. In laser therapy group, at the end of the third postoperative week, PDL 585 nm was radiated. Furthermore, at the end of the sixth week, fractional CO2 laser was radiated. The patients were followed for 6 months after the last laser therapy session. Visual analogue scale was used to rate the appearance of the scar tissues by 3 surgeons blinded to the treatment of scars. The appearance of the scars was determined as poor, fair, good or excellent. 

Results: VAS averaged 5.5±0.8 in laser therapy group and 4.8±0.8 in the control group. The difference was not statistically significant (P=0.057). There was no scar with excellent appearance in the current study. All of the scars were fair and good in the laser therapy group. In the control group, 13 scars were fair. The difference was not significant (P=0.227).

Conclusion: Early combined laser therapy using PDL and fractional CO2 laser was associated with improved appearance of the scar tissue in short-term follow up, however, the effects were not statistically significant.

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Melasma is one of the most common disorders It is an acquired skin pigmentation that occurs especially in sun-exposed areas, mainly on the face. The chronic, recurrent nature and multifactorial pathophysiology of this disease make its treatment associated with significant challenges. In recent years, lasers have been considered as new and complementary methods in the treatment of melasma, but the results reported in different studies have been variable.
The aim of this study is to review the studies conducted on the role of various lasers in the treatment of melasma and compare their effectiveness, safety and limitations. This study was conducted as a review and published articles on the use of various lasers including Nd: YAG, fractional lasers, picosecond lasers, pulsed-dye lasers (PDL) and intense pulsed light sources (IPL) were examined. The findings of the studies were analyzed and compared descriptively.
The results of the review of studies showed that lasers can reduce the severity of melasma and improve the appearance of skin lesions, but the degree of effectiveness and durability of results depends on the type of laser, treatment parameters, patient skin type and compliance with post-treatment care. Among the various methods, the low-fluence Nd: YAG laser has shown the most scientific evidence in terms of the balance between effectiveness and safety. However, the risk of recurrence and complications such as post-inflammatory hyperpigmentation remain important challenges for laser treatment of melasma.
Overall, the available evidence suggests that lasers have an effective role in the management of melasma, but the best results are achieved when these methods are used as part of a comprehensive and combined treatment approach, along with topical treatments and appropriate sun protection.